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Rubin GA, Kirtane A, Weisz G, Baber U, Xu K, Parise H, Stuckey T, Witzenbichler B, Rinaldi M, Neumann FJ, Metzger C, Henry T, Cox D, Duffy P, Brodie B, Mazzaferri E, Mehran R, Stone G. IMPACT OF HEMODIALYSIS AND HIGH PLATELET REACTIVITY ON OUTCOMES FOLLOWING PERCUTANEOUS CORONARY INTERVENTION WITH DRUG-ELUTING STENTS: AN ADAPT-DES SUBSTUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Qiu F, Mintz G, Witzenbichler B, Metzger D, Rinaldi M, Duffy P, Weisz G, Stuckey T, Brodie B, Xu K, Kirtane A, Stone G, Maehara A. CLINICAL IMPACT OF TISSUE PROTRUSION AFTER STENT IMPLANTATION: AN ADAPT-DES IVUS SUBSTUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baber U, Schoos M, Sartori S, Steg P, Ariti C, Weisz G, Witzenbichler B, Henry T, Kini A, Stuckey T, Cohen DJ, Berger PB, Dangas G, Waksman R, Antoniucci D, Krucoff M, Hermiller J, Shawl F, Gibson CM, Chieffo A, Alu M, Moliterno D, Colombo A, Pocock S, Mehran R. TEMPORAL ASSOCIATIONS BETWEEN TIME AFTER PERCUTANEOUS CORONARY INTERVENTION, DUAL ANTIPLATELET THERAPY CESSATION AND STENT THROMBOSIS IN THE CONTEMPORARY PCI ERA: INSIGHTS FROM THE PARIS REGISTRY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kobayashi N, Mintz G, Witzenbichler B, Metzger C, Rinaldi M, Duffy P, Weisz G, Stuckey T, Brodie B, Xu K, Kirtane A, Stone G, Maehara A. INCIDENCE, FEATURES, AND OUTCOMES OF EDGE DISSECTION AFTER DRUG-ELUTING STENT IMPLANTATION: AN ADAPT-DES IVUS SUB-STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Theodoropoulos K, Kini A, Witzenbichler B, Weisz G, Hermiller J, Shawl F, Stuckey T, Chieffo A, Berger P, Cohen D, Waksman R, Aquino M, sartori S, Baber U, Dangas G, Mehran R. IMPACT OF BODY MASS INDEX ON MAJOR BLEEDING AFTER PCI: 2-YEAR RESULTS FROM THE MULTICENTER PROSPECTIVE PARIS REGISTRY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61880-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Parikh P, Kirtane A, Weisz G, Stuckey T, Xu K, Witzenbichler B, Rinaldi M, Neumann FJ, Metzger DC, Henry T, Cox D, Duffy P, Brodie B, Mazzaferri E, Cristea E, Parise H, Mehran R, Stone G. TWO-YEAR CLINICAL OUTCOMES OF SECOND GENERATION VERSUS FIRST GENERATION CORONARY DRUG-ELUTING STENTS: AN ANALYSIS FROM ADAPT-DES. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61899-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gupta R, Kirtane A, Xu K, Witzenbichler B, Rinaldi M, Metzger C, Weisz G, Stuckey T, Brodie B, Mehran R, Stone G. PLATELET REACTIVITY AND CLINICAL OUTCOMES AFTER CORONARY ARTERY IMPLANTATION OF DRUG-ELUTING STENTS IN SUBJECTS WITH PERIPHERAL ARTERIAL DISEASE: ANALYSIS FROM THE ADAPT-DES STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mehran R, Baber U, Steg PG, Ariti C, Weisz G, Witzenbichler B, Henry TD, Kini AS, Stuckey T, Cohen DJ, Berger PB, Iakovou I, Dangas G, Waksman R, Antoniucci D, Sartori S, Krucoff MW, Hermiller JB, Shawl F, Gibson CM, Chieffo A, Alu M, Moliterno DJ, Colombo A, Pocock S. Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet 2013; 382:1714-22. [PMID: 24004642 DOI: 10.1016/s0140-6736(13)61720-1] [Citation(s) in RCA: 454] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) cessation increases the risk of adverse events after percutaneous coronary intervention (PCI). Whether risk changes over time, depends on the underlying reason for DAPT cessation, or both is unknown. We assessed associations between different modes of DAPT cessation and cardiovascular risk after PCI. METHODS The PARIS (patterns of non-adherence to anti-platelet regimens in stented patients) registry is a prospective observational study of patients undergoing PCI with stent implantation in 15 clinical sites in the USA and Europe between July 1, 2009, and Dec 2, 2010. Adult patients (aged 18 years or older) undergoing successful stent implantation in one or more native coronary artery and discharged on DAPT were eligible for enrolment. Patients were followed up at months 1, 6, 12, and 24 after implantation. Prespecified categories for DAPT cessation included physician-recommended discontinuation, brief interruption (for surgery), or disruption (non-compliance or because of bleeding). All adverse events and episodes of DAPT cessation were independently adjudicated. Using Cox models with time-varying covariates, we examined the effect of DAPT cessation on major adverse events (MACE [composite of cardiac death, definite or probable stent thrombosis, myocardial infarction, or target-lesion revascularisation]). Incidence rates for DAPT cessation and adverse events were calculated as Kaplan-Meier estimates of time to the first event. This study is registered with ClinicalTrials.gov, number NCT00998127. FINDINGS We enrolled 5031 patients undergoing PCI, including 5018 in the final study population. Over 2 years, the overall incidence of any DAPT cessation was 57·3%. Rate of any discontinuation was 40·8%, of interruption was 10·5%, and of disruption was 14·4%. The corresponding overall 2 year MACE rate was 11·5%, most of which (74%) occurred while patients were taking DAPT. Compared with those on DAPT, the adjusted hazard ratio (HR) for MACE due to interruption was 1·41 (95% CI 0·94-2·12; p=0·10) and to disruption was 1·50 (1·14-1.97; p=0·004). Within 7 days, 8-30 days, and more than 30 days after disruption, adjusted HRs were 7·04 (3·31-14·95), 2·17 (0·97-4·88), and 1·3 (0·97-1·76), respectively. By contrast with patients who remained on DAPT, those who discontinued had lower MACE risk (0·63 [0·46-0·86]). Results were similar after excluding patients receiving bare metal stents and using an alternative MACE definition that did not include target lesion revascularisation. INTERPRETATION In a real-world setting, for patients undergoing PCI and discharged on DAPT, cardiac events after DAPT cessation depend on the clinical circumstance and reason for cessation and attenuates over time. While most events after PCI occur in patients on DAPT, early risk for events due to disruption is substantial irrespective of stent type. FUNDING Bristol-Myers Squibb and Sanofi-Aventis.
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Kobayashi N, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi M, Mazzaferri EL, Duffy PL, Weisz G, Stuckey T, Brodie BR, Xu K, Stone G, Maehara A. TCT-597 Predictors of Stent Expansion After Drug-eluting Stents: An ADAPT-DES IVUS substudy. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Baber U, Mehran R, Kirtane AJ, Gurbel PA, Christodoulidis G, Witzenbichler B, Weisz G, Metzger DC, Henry TD, Cox D, Duffy PL, Mazzaferri EL, Xu K, Parise H, Brodie BR, Stuckey T, Stone G. TCT-6 Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease: Results from the ADAPT-DES Registry. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Weisz G, Kirtane AJ, Xu K, Stuckey T, Witzenbichler B, Rinaldi M, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Brodie BR, Mazzaferri EL, Parise H, Mehran R, Stone G. TCT-155 The Interaction Between Clopidogrel and Calcium Channel Blockers on Platelet Reactivity and Long-Term Events after PCI. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kang SJ, Mintz GS, Witzenbichler B, Metzger DC, Mazzaferri EL, Duffy PL, Weisz G, Stuckey T, Brodie BR, Xu K, Maehara A. TCT-664 Impact of Obesity on Coronary Atherosclerosis Assessed by Grayscale and Virtual histology Intravascular Ultrasound. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Trenk D, Brodie BR, Büttner HJ, Cox D, Duffy PL, Henry TD, Kirtane AJ, Mazzaferri EL, Mehran R, Metzger DC, Stone GW, Stuckey T, Weisz G, Witzenbichler B, Xu K, Neumann FJ. TCT-156 Impact of Clopidogrel Hyporesponsiveness on Clinical Outcomes in Patients Receiving Drug-eluting Stents for Stable Coronary Disease in the ADAPT-DES Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stuckey T, Kirtane AJ, Brodie BR, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann FJ, Chavez IJ, Metzger DC, Henry TD, Cox D, Duffy PL, Mazzaferri EL, Mehran R, Guerchicoff A, Parise H, Stone G. TCT-5 Relationship Between High Platelet Reactivity on Clopidogrel and Outcomes After DES Implantation: Two-Year Results From the ADAPT-DES Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dong L, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi M, Mazzaferri EL, Duffy PL, Weisz G, Stuckey T, Brodie BR, Xu K, Stone GW, Maehara A. TCT-671 Relationship Between Plaque Morphologies And Clinical Presentation In The ADAPT-DES IVUS Substudy. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kirtane AJ, Stuckey T, Xu K, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Brodie BR, Mazzaferri EL, Cristea E, Parise H, Mehran R, Stone G. TCT-152 Is There a Therapeutic Window For Platelet Responsiveness Among PCI Patients? Analysis from the ADAPT-DES Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Maehara A, Weisz G, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Brodie BR, Stuckey T, Mazzaferri EL, Xu K, Mehran R, Parise H, Mintz GS, Stone GW. TCT-68 Does IVUS Reduce Stent Thrombosis with DES? Two-year results from the prospective, multicenter ADAPT-DES study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Garg A, Brodie BR, Stuckey T, Xu K, Kirtane AJ, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Mazzaferri EL, Mehran R, Stone G. TCT-18 Clinical and Procedural Predictors and Consequences of Stent Thrombosis Following Drug-eluting Stents for Acute Coronary Syndromes: Results From the ADAPT-DES Study. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Weisz G, Kirtane AJ, Xu K, Stuckey T, Witzenbichler B, Rinaldi M, Neumann FJ, Metzger DC, Henry TD, Cox D, Duffy PL, Brodie BR, Mazzaferri EL, Parise H, Mehran R, Stone G. TCT-157 The Effect of Smoking Status on Platelet Reactivity and Long-Term Events after PCI. Does a Clopidogrel-related "Smoker's paradox" Exist? J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tobbia P, Brodie BR, Witzenbichler B, Metzger C, Guagliumi G, Yu J, Kellett MA, Stuckey T, Fahy M, Mehran R, Stone GW. Adverse event rates following primary PCI for STEMI at US and non-US hospitals: three-year analysis from the HORIZONS-AMI trial. EUROINTERVENTION 2013; 8:1134-42. [PMID: 23425539 DOI: 10.4244/eijv8i10a176] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To examine outcomes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) at US sites versus sites outside the US (OUS). METHODS AND RESULTS In the HORIZONS-AMI trial 3,602 STEMI patients in 11 countries were randomised to primary PCI with bivalirudin versus heparin + glycoprotein IIb/IIIa inhibitors. US patients (n=814) had more diabetes, prior infarction, prior bypass surgery, and renal insufficiency. OUS patients (n=2,788) had longer door-to-balloon times, more radial access, fewer bypass surgeries, and were discharged more often on beta-blockers and statins. At three years US patients had higher mortality (9.7% vs. 6.0%, p=0.0003), reinfarction (10.2% vs. 6.4%, p=0.001), major adverse cardiac events (MACE; 28.2% vs. 20.1%, p<0.0001), major bleeding (16.9% vs. 6.4%, p<0.0001) and net adverse clinical events (NACE; 36.6% vs. 23.8%, p<0.0001), which persisted after adjusting for baseline risk. CONCLUSIONS In the HORIZONS-AMI trial, STEMI patients undergoing primary PCI at US versus OUS sites had higher rates of adverse events, which persisted after adjusting for baseline risk. The reasons for these differences are not clear but may be due to unmeasured confounders, different thresholds for event reporting, or valid differences in systems of care and treatments.
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Tobbia P, Brodie BR, Stuckey T, McLaurin BT, Cox DA, Fahy M, Xu K, Mehran R, Stone GW. Are adverse events following an invasive strategy in patients with non-ST-segment elevation acute coronary syndromes more frequent at US sites versus non-US sites? Analysis from the ACUITY trial. Catheter Cardiovasc Interv 2013; 82:E365-74. [PMID: 22887494 DOI: 10.1002/ccd.24587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 07/27/2012] [Accepted: 07/28/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare outcomes between US and non-US (OUS) sites in patients with non ST-elevation acute coronary syndromes (NSTEACS) and to evaluate potential reasons for differences in outcomes. BACKGROUND There are little data comparing outcomes at US versus OUS sites in patients with NSTEACS managed with an invasive strategy. METHODS The ACUITY trial randomized 13,819 patients with NSTEACS in 17 countries to an invasive approach with one of three strategies: (1) heparin plus glycoprotein platelet inhibitors (GPI), (2) bivalirudin plus GPI, or (3) bivalirudin alone. RESULTS US patients were more often female, were younger, heavier, and had more diabetes, prior myocardial infarction (MI), and prior bypass surgery. US patients were less often treated with percutaneous coronary intervention but had more frequent drug-eluting stent use. US patients had lower mortality and higher MI rates at 30 days and 1 year and higher composite ischemic outcome at 30 days. After adjusting for differences in baseline variables, US patients had higher rates of MI and composite ischemic outcome at 30 days and higher rates of MI at 1 year {HR [95% confidence interval (CI)] = 1.36 [1.18-1.56], P < 0.0001} with no differences in mortality. There were no differences in treatment effects comparing bivalirudin with the other strategies between US and OUS sites. CONCLUSIONS US versus OUS patients with NSTEACS had higher adjusted rates of MI and ischemia. The reasons for these differences are not clear but may be due to unmeasured confounders, different thresholds for event reporting, or valid differences in systems of care which may impact outcomes.
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Inaba S, Mintz G, Witzenbichler B, Metzger C, Rinaldi M, Mazzaferri E, Duffy P, Weisz G, Stuckey T, Brodie B, Xu K, Mehran R, Stone G, Maehara A. IMPACT OF POSITIVE AND NEGATIVE CORONARY REMODELING ON CULPRIT LESION MORPHOMETRY: THE ADAPT–DES IVUS SUBSTUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stone GW, Teirstein P, Meredith I, Stoler R, Rabinowitz A, Pompili V, Kabour A, Stuckey T, Curzen N, Saito S, Erglis A, Allocco DJ, Dawkins KD. THREE–YEAR RESULTS OF THE PLATINUM RANDOMIZED TRIAL COMPARING PLATINUM CHROMIUM PROMUS ELEMENT AND COBALT CHROMIUM PROMUS/XIENCE v EVEROLIMUS–ELUTING STENTS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61732-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Inaba S, Mintz G, Witzenbichler B, Metzger C, Rinaldi M, Mazzaferri E, Duffy P, Weisz G, Stuckey T, Brodie B, Xu K, Mehran R, Stone G, Maehara A. MYOCARDIAL BRIDGING DOES NOT AFFECT ATHEROSCLEROSIS IN ADJACENT CORONARY ARTERY SEGMENTS: AN ADAPT–DES IVUS SUB–STUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rinaldi MJ, Kirtane A, Xu K, Witzenbichler B, Weisz G, Neumann F, Metzger C, Henry T, Cox D, Duffy P, Brodie B, Stuckey T, Mazzaferri E, Cristea E, Parise H, Mehran R, Stone G. IMPACT OF POINT–OF–CARE PLATELET FUNCTION TESTING AMONG PATIENTS WITH AND WITHOUT ACUTE CORONARY SYNDROMES UNDERGOING PCI WITH DRUG–ELUTING STENTS: AN ADAPT–DES SUBSTUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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